Doctor? Psychologist? Therapist? Someone Else? How to Find the Best ADHD Treatment Professional

First, the good news: The treatment options for attention deficit disorder (ADHD or ADD) have multiplied exponentially in the last two decades. Newly diagnosed children and adults today can benefit from multimodal therapies orchestrated in partnership with a variety of medical professionals, therapists, and other specialists, each with unique benefits and strategies.

Now, the bad news: Choosing the most affordable and effective treatment options is overwhelming at best, and downright daunting for many patients and families living with ADHD. Who can prescribe medication? Who can administer diagnostic tests? Who can offer counseling? Who is available for more than 15 minutes at a time?

Here, we answer those questions and tell you what you need to know to pick the best professionals for your family and to pursue the highest standard of ADHD care.

Your family doctor, also known as your primary-care physician (PCP), is responsible for your overall health care. So it’s no wonder so many people start here when they first suspect symptoms of ADHD — in fact, in a 2017 ADDitude survey, more than 44 percent of respondents sought an initial evaluation and diagnosis from their PCP, and 35 percent said their PCP continues to oversee treatment for their child or themselves.

PCPs are able to diagnose ADHD and prescribe medication, however their time and detailed knowledge of ADHD may be limited. While PCPs receive some general training on ADHD and other mental health conditions during medical school, many offer only basic care — primarily medication management. Many refer their patients to specialists for more advanced ADHD treatment.

At the same time, it is true that some primary care doctors have elected to take additional courses on ADHD and other mental health conditions, and are comfortable identifying symptoms and setting up a well-rounded treatment plan. Ask your PCP about her experience with ADHD, and don’t hesitate to ask for a referral if her knowledge of the subject appears incomplete.

Visits to primary care doctors are covered by insurance.

A pediatrician who believes your child has developmental challenges will likely refer you to a developmental and behavioral pediatrician. Like PCPs, developmental and behavioral pediatricians are medical doctors who can diagnose mental health conditions and prescribe medication. This doctor, however, has additional training in learning disabilities, developmental disorders, and other behavioral challenges, and may provide a more specialized evaluation, counseling, and treatment plan than your family doctor can.

One quarter of people surveyed by ADDitude said their child has saw a developmental and behavioral pediatrician for diagnosis; 15 percent of families surveyed continued to see one for treatment as well.

During a typical evaluation, the developmental and behavioral pediatrician will examine your child’s nervous system, noting physical strength and coordination as well as behavior, social responsiveness, and speech. They are trained to look for learning disabilities, attention and behavioral disorders, sleep disorders, tics, and other developmental and behavioral symptoms that go beyond ADHD. If your child requires further specialized testing, this doctor can usually help you coordinate it.

Medical coverage varies, but many services provided by a developmental and behavioral pediatrician are covered by insurance.

[Free Handout: 6 Steps to a Thorough ADHD Evaluation]

A psychiatrist is a medical doctor who specializes in psychiatry, which means he or she has completed medical school and received specialized education and training in diagnosing and treating mental health disorders, such as ADHD, mood disorders, and anxiety. Psychiatrists understand the complex relationship between physical and emotional disorders, as well as the benefits of multimodal treatment plans.

More than 48 percent of ADDitude readers surveyed said they have seen a psychiatrist for their child’s or their own ADHD treatment.

Psychiatrists can prescribe medication. Some do provide talk therapy, but many focus primarily on medication management. In instances where talk therapy or other treatment strategies are deemed necessary, psychiatrists frequently work with other therapists — psychologists, social workers, or counselors — to balance medical and non-medical interventions.

Visits to psychiatrists are covered by most insurance plans that cover mental health care.

A psychopharmacologist is a medical doctor (either an M.D., psychiatrist, or Doctor of Osteopathic Medicine) who specializes in the medications used to treat mental and emotional disorders. According to the American Society of Clinical Psychopharmacology (ASCP), the discipline revolves around two main principles: “pharmacokinetics (what the body does to medication) and pharmacodynamics (what the medications do to the body).”

If your primary care doctor or psychiatrist is trained in psychopharmacology (as many are), you need not see a psychopharmacologist on a regular basis. However, your ADHD professional team may choose to consult with one about your medical care, particularly if you take medication for several mental health conditions concurrently.

Since many are primary care doctors or psychiatrists, psychopharmacologists’ visits are covered by most insurance plans.

A psychologist has an advanced degree in psychology (Ph.D. or Psy.D). Traditionally, psychology Ph.D.s worked primarily in research or academia, but today many are clinical psychologists who actively treat patients. State laws for licensing of psychologists vary; in most states, psychologists can diagnose ADHD and other mental health disorders, but cannot prescribe medication. In New Mexico, Louisiana, and Illinois, “appropriately trained” psychologists can be granted the right to prescribe medication. The definition of “appropriately trained” varies by state; a brief summary of each definition is available from the APA Practice Organization, an offshoot of the American Psychological Association.

More than 35 percent of ADDitude readers surveyed said they have seen a psychologist for their child’s or their own ADHD treatment.

Psychologists primarily treat patients using talk therapy, most often psychotherapy or cognitive behavioral therapy. If medication is needed and the psychologist is unable to prescribe, he or she may coordinate with a psychiatrist or medical doctor to manage a patient’s complete treatment plan. Some psychologists, like Thomas Brown, Ph.D., argue that non-prescribing clinical psychologists should play a more proactive role in the complex (and often overlooked) medication management process, encouraging them to educate patients about medication and actively help patients track and share information about side effects and medication efficacy with their prescribing doctors.

Visits to psychologists are covered by most insurance plans that cover mental health care.

The term “counselor” covers a broad spectrum of professionals who have specialized training in particular types of therapy, such as talk therapy or cognitive behavioral therapy. Definitions of the terms “licensed mental health counselor” (LMHC) and “licensed professional counselor” (LPC) vary by state, but mean essentially the same thing — they are licensed by a state board to provide professional counseling-based mental therapy. While qualifications and training will vary from person to person, most LMHCs and LPCs have at least a master’s degree in either psychology or counseling. Many counselors are qualified to complete initial assessments and provide a diagnosis of ADHD, but some choose to refer patients to a psychologist or psychiatrist for a more in-depth assessment.

According to the ADDitude treatment survey, 39 percent of all children and adults with ADHD have seen a “counselor or other therapist” for treatment.

Since counselors cannot prescribe medication, they typically focus on helping patients work through the difficult emotions and psychological challenges associated with ADHD. Marriage and family counselors can also help patients repair relationships strained by ADHD symptoms.

Though insurance plans vary, counselors are usually covered, and are frequently less expensive to visit than are psychologists or psychiatrists.

[Free Resource: The ADDitude Guide to Alternative Treatment]

A neurologist is a medical doctor who specializes in disorders of the brain, spinal cord, and nervous system. While ADHD and other mental disorders fall under this category, they’re usually not a neurologist’s primary focus. However, these doctors may play a unique role in the diagnostic process, particularly if another medical professional suspects you have a seizure disorder, brain tumor, or Tourette’s syndrome alongside your ADHD. Many of the tests neurologists perform — including EEGs, MRIs, and other brain scans — are not necessary to diagnose ADHD itself, however, and may be expensive.

Nearly 19 percent of ADDitude readers surveyed saw a neurologist during the evaluation and diagnosis process; 8 percent reported continuing treatment with a neurologist following an ADHD diagnosis.

Neurologists can prescribe medication to treat ADHD, but most refer patients elsewhere if any additional treatments are deemed necessary.

Neurologists are considered specialists, and typically fall under certain insurance restrictions. Make sure any neurologist you choose is in your network, and discuss any out-of-pocket costs before undergoing complex tests.

Neuropsychology is a relatively young branch of psychology that studies how specific structures of the brain relate to psychological disorders and patterns of behavior. While not a medical doctor and unable to prescribe medication, a neuropsychologist has special training in the biological and neurological bases of learning and thought, and is therefore able to fully assess patients’ cognitive and behavioral functioning. Many neuropsychologists work in research settings, but they can also work directly with patients in clinical environments.

When treating a child, a neuropsychologist makes recommendations about school placement and overall care. When treating an adult, he or she often recommends a comprehensive treatment plan that may include therapy, medication, or other interventions; other specialists typically administer these services.

Neuropsychological testing is not commonly covered by insurance. That said, it may be possible to request reimbursement from your insurance company, under certain parameters. Check the details of your plan before setting up a neuropsychological consultation.

Psychiatric-mental health nurses (PMHN) have undergone specialized training to work in psychiatric hospitals and treatment centers. These nurses can assess the mental health needs of individuals, families, or groups — and serve as patient advocates and crisis intervention specialists. PMHNs must complete a standard degree in nursing — either an associate’s or a bachelor’s — pass a nursing licensing examination, and receive additional education in working with patients with mental and emotional disorders. Most psychiatric nurses do not diagnose ADHD and cannot prescribe medication, though some are able to do so (see Psychiatric APRNs, on the next slide.)

Since PMHNs work in concert with hospitals, psychiatrists, and other physicians, they often fall under the same insurance designation as those professionals.

Psychiatric mental health nurses who have obtained a master’s or doctoral degree in the field achieve the title of psychiatric advanced practice registered nurses, or psychiatric APRN. State laws vary when it comes to APRNs’ accreditation requirements, prescribing abilities, and required level of oversight. But in most cases, an APRN can diagnose, prescribe medication, and provide therapy for ADHD and related psychological conditions.

A recent study (funded by a nursing advocacy group) focusing on the efficacy of APRN care found that the practice is safe, cost-effective, and produces care results similar to those of a primary care physician or other medical doctor.

Visits to APRNs are usually covered by insurance.

A nurse practitioner is a type of APRN who has pursued the further education and specialization needed to serve as a primary care provider for children and adults. Nurse practitioners often work in private practice — either on their own or in partnership with primary-care physicians — but may work in hospitals or clinics as well. Though some NPs have limited knowledge of ADHD, others — depending on the nature of their specialization — are comfortable diagnosing and treating the condition, along with common comorbid conditions. Psychiatric NPs, in particular, are able to assess for the presence of ADHD and devise a general treatment plan.

In the U.S., NPs can prescribe medication, though in some states, they must collaborate with a physician to do so. If more specialized care is needed, NPs can refer patients to specialists. In some small studies, NPs outscored traditional physicians in terms of patient satisfaction.

Visits to nurse practitioners are usually covered by insurance, making them a convenient and effective treatment option for many families.

Licensed clinical social workers (LCSW) are professionals who have obtained a Master’s degree (or higher) in social work and have been licensed by a state board to provide mental health services. LCSWs can be employed by an agency or a hospital, but they frequently work in private practice as well, serving functions similar to those of therapists, counselors, and psychologists. They can diagnose ADHD and related conditions, and can recommend treatment strategies, but cannot prescribe medication.

LCSWs usually sign an ethics pledge given by their state’s social work board, and thus adhere to high ethical standards for patient care. They excel at providing emotional support to patients and their families, and are often helpful in locating resources and community services for patients.

Insurance plans that cover mental health services will usually cover visits to a LCSW.

Occupational therapists are licensed professionals — usually with a Master’s degree or higher — who help children and adults with motor deficits, sensory processing challenges, and underdeveloped social skills to function better in day-to-day life. While they can’t prescribe medication, OTs can diagnose the conditions they treat and plan comprehensive, hands-on treatment plans. A child with SPD who can’t stand the feeling of tags on his skin, for instance, would likely benefit from OT visits; an adult with dysgraphia — a learning disability that hinders handwriting and fine motor skills — would be a good candidate for occupational therapy as well.

OTs may work out of a school, in private practice, or within a hospital setting. In the U.S., a growing need for occupational therapy means that many OTs conduct home visits or travel around the country to temporarily fill treatment gaps.

If you pursue OT outside of your child’s school, be aware that many insurance plans cover occupational therapy only for certain diagnoses. Call your insurance company to figure out exactly what it will cover before starting occupational therapy for yourself or your child.

ADHD coaches are not medical professionals; rather, they are guides, teachers, and cheerleaders who help teach organizational, time-management, and goal-achieving strategies to teens and adults with ADHD. They work with individuals to improve specific lifestyle skills, such as organization, and to find non-medical ways to better manage ADHD symptoms. A coach could help a college student with ADHD learn how to better manage her workload, for instance, or help an older adult with ADHD better organize her home and reduce her daily stress. Many coaches have ADHD themselves, and are thus acutely aware of the challenges it presents and the best strategies to find success.

There are no standards for licensing ADHD coaches, but certification programs do exist. Coaches are also bound to a code of ethics and to core competencies.

Coaches are rarely covered by insurance, and are also not able to diagnose ADHD or prescribe medications.

[When To Fire Your Doctor]